Increasing Representation of Epidemiologists From Around the World in the Society for Epidemiologic Research: The Case of Mexico

Abstract

Mexico has a population of 129 million and is considered one of the most unequal countries in the world, suffering from widespread health disparities. There is a pressing need to strengthen epidemiologic capacity in Mexico, to help solve the complex health problems the country faces and to reduce health inequities. However, the representation of Mexican epidemiologists in the largest epidemiologic society in North America is low, despite the short distance to the United States. In this commentary, we discuss the barriers to higher representation of Mexican epidemiologists within the Society for Epidemiologic Research (SER), including language barriers, costs, and regional necessities. We also discuss opportunities to expand Mexican SER representation and collaboration. Overall, we hope that this is a call towards expanding SER global participation and starting a conversation on a common agenda for epidemiologic research.

Abbreviations

COVID-19

coronavirus disease 2019

PASPE

Programa de Actualización en Salud Pública y Epidemiología

SER

Society for Epidemiologic Research

Editor’s note: The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the American Journal of Epidemiology.

As the oldest and largest epidemiology society based in North America, the main goal of the Society for Epidemiologic Research (SER) is to create a venue for trainees and professionals of all levels to present research findings, discuss methodological innovations, exchange ideas, and establish a community in which epidemiologists can come together and learn from each other. Within the SER, the Diversity and Inclusion Committee aims to foster the diversity of membership and engagement of all members, from diverse backgrounds, at all stages of their careers, in the Society’s activities, with the intent of enhancing discovery in public health.

The SER understands that diversity of thought, background, and approach not only is morally just but creates context for both personal and professional enrichment. The benefits of increasing diversity and inclusion and representation in science have been well documented, including improved research quality (1), higher productivity and innovation (2, 3), feedback from diverse subgroups of the population (4), and increased breadth of expertise (4, 5). Within epidemiology, this could translate to novel approaches to address regional and global current health problems, better understanding of health risk factors among different communities, initiation of new collaborations, and the strengthening of existing collaborations. In a recent American Journal of Epidemiology article on the role of diversity, Ðoàn et al. (6) recommended that the SER support the growth of a diversifying workforce and increase the visibility of health disparities research in epidemiology. The steps that the SER has taken to increase diversity and inclusion and representation have been previously documented (7).

With this goal in mind, each year a country is highlighted at the SER’s annual conference. This year’s (2022) highlighted country was Mexico. Mexico represents an ideal opportunity to develop and foster academic collaborations for students and faculty to study disease patterns, causes, and potential solutions for the problems faced by the Mexican population living in Mexico and in the United States. Despite the potential opportunities to collaborate and the geographic proximity, Mexico is underrepresented in the SER. Below we describe some ideas on how to expand SER collaborations and create novel opportunities for epidemiologic research in Mexico.

MEXICO—A BRIEF INTRODUCTION

Public health overview

Mexico has a population of 129 million, out of which 42% live below the national poverty line, unable to afford the basic food basket (8) and basic services (9, 10). Though it has the 15th largest economy in the world, Mexico is also considered one of the countries with the highest level of inequality. Although many aspects of health have improved (for example, life expectancy is now over 75 years), it still suffers from widespread health disparities. Mexico’s infant mortality rate remains the highest in the Organisation for Economic Co-operation and Development (13 per 1,000 live births as compared with the Organisation for Economic Co-operation and Development average of 3.8 per 1,000 live births), and the breastfeeding rate is one of the lowest in the world (10). Cardiometabolic diseases are the main cause of death in the country, followed by cancer and violence. Obesity prevalence in the adult population is 32.4%, making it the country with the third highest prevalence of obesity in the Americas, behind the United States and Canada (11). Obesity has been on the rise for the past 30 years (12). Moreover, nearly 14% of Mexicans suffer from diabetes—one of the highest rates of diabetes in the world (3)—and chronic kidney disease secondary to diabetes is very frequent. Finally, the national health budget in 2018 represented only 2.3% of the total federal budget (13).

Health disparities

Health conditions differ among social classes, with disadvantaged groups such as the poor and indigenous populations experiencing higher rates of morbidity from unsafe water supplies, infections, respiratory diseases, and violence. Violence is a major public health issue in Mexico. The violence is strongly socially and spatially patterned (14), but it also shares important links to commercial determinants of health, such as national and international drug, alcohol, and firearm markets. Violence has caused important losses in life expectancy, particularly among men aged 15–49 years (15). For women, femicide is part of the reality of life in Mexico (16).

Coronavirus disease 2019

The coronavirus disease 2019 (COVID-19) pandemic showed different risks according to the population structure and the prevalence of chronic diseases (4). Large heterogeneity in the COVID-19 infection fatality rate has been observed within the country, with Mexico City experiencing the highest death toll and high lethality rates among young adults (17). The high prevalence of chronic disease, along with poverty and structural shortcomings of the health system, have been proposed as the main reasons behind the lethality observed in the country. The pandemic has led to more than 600,000 COVID-19 and non–COVID-19 excess deaths (18, 19).

This short overview shows that Mexico faces complex health problems, rooted in deep inequality and poor structural conditions, coupled with a weak health system. There is a clear urgency to incentivize the conduct of more epidemiologic studies in Mexico to solve these problems and reduce the inequities observed in the country (5). However, while the number of epidemiologists in Mexico is larger than in other countries in Latin America, it is modest compared with the United States, and only a few institutions—such as the Mexico National Institute of Public Health (20), the National Autonomous University of Mexico (21), and the University of Guadalajara (22)—offer graduate training in epidemiology.

LOW REPRESENTATION OF MEXICO IN THE SER AND POTENTIAL SOLUTIONS

Over the years, the SER has expanded throughout the United States and other countries. Currently, the SER membership includes people from approximately 51 different countries. However, the representation of Hispanics in the SER is still low. Based on the SER’s membership roster data from 2018, 6% of members were Hispanic, compared with 62% White (6). Country of origin is not reported, and thus we cannot infer how many SER members identify as Mexican. Further, in a recent diversity and inclusion survey, only 41% of survey respondents reported feeling very welcomed at SER-sponsored activities, including the annual meeting; this figure varied considerably by race/ethnicity and sex (6). We note that survey respondents were a minority of SER members, and perhaps not representative.

Opportunities

The SER could offer important benefits to Mexican epidemiologists and epidemiology students; unfortunately, the Society is not widely known in Mexico, and thus the benefits and opportunities available need to be made more transparent. Current regional workshops are offered through the National Institute of Public Health, such as the Programa de Actualización en Salud Pública y Epidemiología (PASPE), which is an excellent and affordable opportunity to learn specific skills. However, PASPE is not a substitute for what can be gained from attending larger SER conferences with leading international and US-based researchers, opening opportunities for potential collaborations. SER membership includes access to valuable resources, such as engagement with other societies to encourage interdisciplinary research (SERcollaborations), career development events featuring experts in the field on a specific topic area (SERexperts), or quarterly half-day to full-day workshops across the country featuring an expert on key epidemiology topics (SERtalks), among others. In addition, SER members have access to reduced rates for the annual meeting, access to the job board, and access to networking and mentorship opportunities. However, the depth of some of these opportunities is not immediately clear to all people; the addition of brief explanatory videos about what those opportunities entail could help members understand their benefits.

Regional needs/interests

On the other hand, to increase participation from epidemiologists in Mexico, it is worth considering what is needed in the country. In Mexico, as well as in other Latin American countries, epidemiologists personally cover all aspects of a project—for example, keeping track of administrative records, conducting local surveys, analyzing local data, and interacting with governmental authorities (23). With multiple responsibilities, it is crucial to consider what type of training, mentorship, and workshops would be helpful for their everyday work. Other international societies have created regional chapters that can tailor activities and resources to more specific needs of the region (24). For example, a Latin America chapter of the SER could focus on promoting and strengthening scientific collaboration in epidemiologic research in Latin American countries and identify common health problems, risk factors, and/or analytical interests specific to the region. Similarly, it is important to promote academic exchange, collaboration, and training in epidemiology in the region. In a recent commentary on promoting diversity and inclusion at the annual SER meeting, Zhang et al. (9) proposed increasing identity meetups (e.g., people of Hispanic heritage) and promoting them online (e.g., @Black_epi resulted from the “BlackEpi meetup” held at the 2019 annual meeting). Similarly, having a “Hispanic meetup” at the annual meeting and promoting it as @Hispanic_epi could spur novel collaborations and increase the visibility and participation of Latin American and Latin America–interested epidemiologists.

Cost

The cost of SER membership may not be accessible for Mexican students, let alone the cost of attending the annual conference, including travel expenses. For example, for programs that provide a scholarship (and not all of them do), the average stipend at the master’s level is US$591 per month (US$709/month at the doctoral level) (25). The discounted SER membership fee without access to the Journal represents a little less than 10% of the monthly stipend for a student in Mexico; that could be reasonable if the benefits are clear and sound. Johnson and Chin (7) reported that early-career members are more racially and ethnically diverse than senior members, suggesting that reducing financial barriers to conference participation might be an important consideration for increasing diversity among conference attendees. The organization of conferences in locations that are convenient (southern states closer to the Mexico-US border), with inexpensive air connections or where lodging is cheaper, could help reduce the financial burden and other barriers to conference attendance. Increasing scholarships for students to attend the annual meeting, including travel costs, is crucial to increase representation from trainees in Mexico and even for faculty that may not be able to afford US costs. The scholarships could be based on merit, to ensure diversity in the type of work that epidemiologists from Mexico are doing. In a recent commentary on promoting diversity and inclusion in the SER, Zhang et al. (8) also proposed expanding financial support to all epidemiologists-in-training from historically disadvantaged backgrounds.

Language

Lastly, while many students in Mexico and Latin America can read English, they may not necessarily feel comfortable speaking in English or listening in seminars at a scientific conference. SERvisits sends SER researchers to give scientific presentations at institutions that are underrepresented at the annual meeting and provides financial support to epidemiologists-in-training with “underrepresented backgrounds” from those institutions to attend the annual meeting. Holding more SERvisits presentations or SER workshops at Mexican institutions, in Spanish or with translation available, could be a great way to increase SER visibility in Mexico, and perhaps even increase representation among board members and in leadership positions.

A regional seminar—a call for collaborations

In Mexico, analyses have highlighted how inequalities are reflected in differential access to health services and health outcomes in the population, with socioeconomic status representing a major driver of inequality (26). Researchers have also evaluated the genetic epidemiology of cardiometabolic diseases (27) and neurodevelopment (28) in Mexicans. Environmental epidemiologists have studied the relationship between lead exposure and health outcomes such as blood pressure (29) and cognitive abilities (30) in Mexican children. In a recent study, Bertado-Cortés et al. (31) comprehensively described the epidemiologic and clinical features of multiple sclerosis in a large cohort of patients from 8 tertiary-level health-care centers in Mexico. This is just a small sample of recent studies that have been conducted in Mexico, yet there is still much to do. Research infrastructure is available through cohort studies such as Estudio de Salud de las Maestras (ESMaestras) or Early Life Exposures in Mexico to Environmental Toxicants (ELEMENT), and regional efforts such as the Salud Urbana en América Latina (SALURBAL) Project are being undertaken (32–34).

An SER regional annual seminar focused on promoting and strengthening scientific epidemiologic research in Mexico and other Latin American countries could consolidate a collaborative network of Hispanic/Latin-American members of the SER. Notably, the SERvisits program has been successful in creating mutual exchanges between SER members and underrepresented institutions. This would also help to identify common epidemiologic health problems and promote academic exchange and training in epidemiology in the region.

CONCLUSION

Because of its close geographic proximity with the United States and many shared health challenges, Mexico represents an ideal opportunity to expand SER collaborations and improve diversity and inclusion within the Society. However, other countries could also greatly benefit from greater integration into scientific societies like the SER. With the long-term goal of worldwide collaborations, we propose to strengthen US-Mexico collaborations as the first step. We see this as the start of a conversation on global representation in the SER and epidemiologic research.